Class of 2017
“I don’t want these anymore,” I say, avoiding my doctor’s gaze as I reach into my purse and retrieve the pill bottle, half empty. Or half full, depending on how you look at it. I place it on her desk. She looks from the bottle to me, her expression curious, no doubt wondering where to go from here. She expected to do my Pap test today, perhaps give me a flu shot, but did not anticipate this: a discussion about my antidepressants.
She asks me to explain. She asks whether the meds have helped with my mood. “Oh yes, they have, and my energy’s better too,” I tell her. “I’m able to enjoy time with my kids again. I actually want to get out of bed in the mornings and feel able to face the day. But still, I want to stop; I shouldn’t need to take these pills.”
“It’s embarrassing, to need this,” I continue, and that’s when I feel the familiar shame creeping in. It envelops me in its invisible cloak and steadily tightens until it feels impossible to continue breathing. Then the tears break through; I’ve been holding them in so long. I have a job, a family, good health. So why do I need these? What is missing for me? What is wrong with me? These questions I’ve asked myself a million times, but no answer has ever come.
“I don’t like the idea of needing this to feel better,” I explain. These words make me feel more confident and rational somehow. “I shouldn’t need to take something to feel better. I should be stronger than that.”
I let my words hang in midair and wait for affirmation from her, my doctor. The one who has cared for me all these years and who knows my intimate secrets. The one who delivered my children, who has seen me in my brightest and my darkest moments. I beg for her validation with my eyes and with my silence, but it never comes. I begin wondering which person in the room I am trying to convince.
Left with silence, I do what we all do: I fill it with my words. I explain that my husband keeps asking when I’m going to stop taking these pills. “You know how he is,” I say. I think of my kids and how they take vitamins shaped like dinosaurs every morning: small, colourful creatures that help them grow strong bones, muscles and minds, for running and playing and imagining and doing the amazing things children do. Like I used to when I was small and carefree, before things changed.
“When my kids ask me what these pills are that I take every day, I tell them they’re mommy’s brain vitamins; they help mommy so she can work and have fun and go to the park. But what will they think when they get older?” I ask my doctor. “I know the day will come when they wonder: mom is depressed, but why?” At this point I’m red and puffy-eyed, letting out all the emotion I haven’t allowed myself to show to my family, to my friends, to anyone. “It’s been so hard for me, Doctor, with all the judgment out there towards people like me, taking these pills; I just can’t handle it any longer. I don’t want to need this medication anymore.”
And then, at long last, my doctor speaks.
“I am going to say something controversial,” she cautions me. She’s always been the one to prescribe tough love in the perfect dose for me; what I need to hear, though I may not realize it at the time. Her words will stick with me for years to come and will change my path: Is this what you want, or is this what you have been led to believe you should want? And why are you stigmatizing yourself?
This is a reflection on several patient encounters I observed during a family medicine clerkship rotation, and also combines elements of interactions with family members and friends who all have their own perspectives on mental illness. I’ve often heard about initiatives to combat the stigma held against others with mental illness, but before this patient encounter, I had not spent much time thinking about the effect of patients stigmatizing themselves. I hope this piece serves to remind us of the pervasiveness of stigma, and the need to be aware of it infiltrating not only our perceptions of others, but also of ourselves.